March 8, 2012

The New York Times Magazine has a story, "America Is Stealing the World's Doctors," that focuses on an Indian who grew up in Zambia, went home to India to study medicine, then tried for a few years to be a surgeon in Zambia. He gave up and is now becoming a doctor here. The pay is 10 times better and the working conditions are too. But what about the huddled masses of Zambians needing doctor's care? Zambia has 1 doctor for every 23,000 people.

Since everybody else in the New York Times is talking about contraception, I looked through this article to see if there was any mention of the concept that maybe what Zambia needs is relatively fewer but healthier Zambians.

Of course not.

So, what is the Total Fertility Rate in Zambia?

It's 6.28 babies per woman per lifetime. That appears to have gone up slightly over the last decade, assuming that these kind of statistics out of Zambia can detect small trends. In any case, that's a huge TFR.

The mortality rate in Zambia is very high, but the population has still grown by 50% over the last 20 years.

It would seem hard to think about health care in Zambia without at least considering issues of contraception, yet the whole topic is routinely ignored when thinking about Africa.

75 comments:

The only issue with contraception is how unaffordable it is to upper middle class educated white professional women, whom we definitely want to contracept themselves lest their high quality genes be passed onto the next generation.

It's all about choices. And the choice to have a family at 40 or whatever these women do is totally natural and not coerced by debt, propaganda, social pressure, etc.

From Wikipedia: "Zambian-born Archbishop Emmanuel Milingo was a high-ranking Bishop at the Vatican until he left to marry Maria Sung, a 43-year-old Korean acupuncturist, at a ceremony officiated by the Rev. Sun Myung Moon in New York (May, 2001). He was ex-communicated by the Roman Catholic Church in September, 2006 for conducting a consecration of 4 married men as bishops."

Bishops taking wives makes it seem to me that in Zambia contraception might be just what the doctor disordered. Though this married Zambian bishop might find it apt to keep his acupuncturist wife away from his stock of Ramses.

The New York Times Magazine has a story, "America Is Stealing the World's Doctors," that focuses on an Indian who grew up in Zambia, went home to India to study medicine, then tried for a few years to be a surgeon in Zambia. He gave up and is now becoming a doctor here. The pay is 10 times better and the working conditions are too. But what about the huddled masses of Zambians needing doctor's care?

India itself has an abysmally low doctor-patient ratio. Yet indian doctors keep leaving the country that educated them and that desperately needs their services in droves.

Ditto for engineers and scientists educated in India. This aspect of globalisation may benefit America but it really hurts India, Africa etc

Isn't this where the fun starts? Those huddled masses need to spread their wings and fly away to greener pastures up north. These people are needed in a Toronto suburb or Birmingham Council House. I believe they are called "pension savers" in Sweden and "job savers" by social workers and bureaucrats the Western World over.

I ask this question in all seriousness.Has somebody actually gone through the trouble to find out what efforts are actually being made in these countries regarding birth control? Everyone seems to have an opinion, but other than fertility rates (I have been lead to understand that they have been basically plummeting everywhere---including (most) third world countries---for decades) I have seen no information regarding actual policy here. It's just that there seems to be this assumption that wherever fertility is an issue, it's due to A Lack Of Availability, Access, And Information About Contraception(the obligatory snarky "TM" here). This is generally followed by a dubious claim of some sort of Powerful Papist Conspiracy to Prevent Oppressed Peoples of Color from Getting Access. I don't know, but I serious doubt that various organizations, non-profits, women's groups, etc., haven't been very active in this area. And I have trouble believing that there's much else to be done, at least on a voluntary basis. I wish Steve would be a little more concrete regarding what he has in mind here.

The NYT, eh. The same people who said Depoprovera shots were inflicting even more HIV on E. Africa. Their mentality is probably closer to, "So long as they don't overflow into nice Western lands, what's not to like? My daughter works at an NGO that ships charitable CT scanners thatta way"

African eschewal of contraception is going to make them a power to be reckoned with after Asia and Europe flop demographically, which will happen in 20 years.

IQ is important, but it's important in the context of differentiating between actual living humans. It has very little to say about the difference between hypothetical people and real people. In that latter category, real people win everytime, no matter how high the average IQ of the hypothetical populace is.

Sometime ago there was a do-gooder idea to send laptops to every child in Africa. I'm not sure of the country in question, but as long as the recipients were black, and the donors could get in an out alive, I'm sure it didn't matter.As it turned out most the computers were sold on the black market. I always thought providing every schoolperson over the age of 12 (or maybe 10) with contraceptives or better yet, a contraceptive vaccine, would do far more to promote the well being of Africans and everyone who ever has to deal with their overflow.

Hey, someone has to do the dirty work of growing the future pension and medicare funders for the West.

You can't expect travel writers, shoe designers, fashion writers, museum guides, Planned Parenthood volunteers, rape counselors, public relations professionals, aspiring actors, and such to take time off from their fulfilling and meaningful careers to have children above replacement rate especially while they live in "vibrant" cities where "the rent is too damn high" and give nary a thought to issues like Affordable Family Formation and how AFF is affected by the trendy social policies they so luv to use as the basis for their posturing displays.

Secondly, everyone knows that the it's the natural order of things for retiring physicians, lawyers, accountants and other high paid professionals to expect to a.) have their pensions paid for, and b.) be replaced by, new immigrants. Look how wonderfully it's projected to work for Texas.

I thought the laws made it very difficult for foreign trained doctors to practice in the US. The lab where I worked in college was chock-full of mainland Chinese medical doctors who were doing lab work at $20-$30K/year.

the United States, with its high salaries and technological innovation, is also the world’s most powerful magnet for doctors, attracting more every year than Britain, Canada and Australia — the next most popular destinations for migrating doctors — combined

In other words it is the white majority Anglosphere that is sucking in all these colored doctors from poor impoverished nations like India, Zambia, Ghana, Nigeria, Pakistan etc. who are all desperately short of doctors.

What do all these poor third world countries have in common? They were all part of the British Empire.

The fact that all these countries educate their doctors, engineers, scientists in the english language has got to be a major reason why so many of them end up in the US, UK, Canada and Australia.

Steve -- Contraception tends not to be used (even places like Algeria and Iran, not exactly hotbeds of feminism, have TFR of 1.7 or so) when your security is children.

I'm surprised you did not get this. People with uncertain futures, who feel their only wealth is having lots of kids, have lots of kids. Using contraception requires a low mortality rate, and the ability to save and secure wealth in some fashion.

Look at for example, Mexican fertility in the US. Mexican teen girls have far higher rates of pregnancy than White or Asian peers, and even IIRC according to some studies to Mexican-resident peers. Having a kid at age 16 means giving up money, opportunity (like marriage to a hot guy), any kind of a career, and low-income work basically forever. That Mexican girls in large numbers make that choice tells you about what they feel the things they give up options on are likely.

Given how cheap contraception is, high fertility is a function IMHO of low confidence in the future.

Matt -- Not just the Incas and Aztecs, but the Europeans, who were outnumbered by Asians and Africans and yet still conquered them.

Technology kills, and newer technology kills faster and more effectively all the time. Right now the West is filled with Nice White Ladies who find the idea of violence repulsive and hope to "win over those bad boys" like a bad romance movie. China suffers no such compunction (when a Chinese young lady laughed at their beta boys and said she'd rather cry in the back of a limo than be happy on the back of a motorcycle -- the dating show she was one was quickly canceled). It is filled with angry, ambitious young men who will not find a girlfriend without something major (like conquering a neighboring country and killing all their men). China looks at Africa as easy meat, basically. Ask the Tibetans how enlightened the Chinese are about other nations and peoples.

The people of Africa have no defense, none, against nukes, bio-weapons, chemical weapons, not to mention regular old bombs, air attacks, tanks, and such. Mogadishu only works when Clinton is President and the Nice White Ladies get the vapors over non-Whites getting killed (i.e. current Western morality is a luxury good that is long-term unaffordable). Africa is totally dependent on American protection and Chinese goodwill (or ours come to think of it). That is not a good place to be, historically.

Ditto for engineers and scientists educated in India. This aspect of globalisation may benefit America but it really hurts India, Africa etc."

It may benefit "America" - the notional enterprise zone that is the world's bazaar - but it does not benefit Americans. And, as you pointed out, it also really hurts those countries that are losing highly trained professionals whom they desperately need.

"I thought the laws made it very difficult for foreign trained doctors to practice in the US."

They do have to jump thru a lot of hoops, but so many of them that a lot get thru: about a quarter of all doctors in the US are foreign-trained.

They have do a residency in the US, and they congregate in non-competitive specialties like primary care. Although their visas mostly are for training purposes only, they tried like hell to stay afterwards, and often succeed.

You can't blame them for trying. Incomes ($180K to $600K+ depending on specialty) have no comparison to any other country on earth.

Weird how contraception is the hottest issue of 2012 apparently... I would not have expected the most vocal subset of the "pro" side to be so defensive and crazy as hell about it. I think there's more of a chance of the Volstead Act coming back, not that I'd know any better from this Great Progestin Awakening last week.

I happened to hear a replay of Sean Hannity's show and don't know if the piece was normal programming: debate with some Fox News woman vs. another from Cornell's medical campus in NYC. The medical woman was, sorry, hysterical--practically shrieking into her phone. Small stakes = vicious politics naturally. If you said "Zambia" to them they'd surely just stare in puzzlement.

For example, Nigeria is on track to double in population before mid-century. Not being a CFR graybeard it sounds potentially really consequential to me, however they are uncharacteristically free of advice, even on the Muslim element which may or may not be getting out of hand. If it isn't to do with an OPEC tantrum, their bootleg movie industry, or lame grad-student cracks about e-mail scams the Nigerians are old masters at ducking the East Coast intelligentsia.

Isn't this just class war by the New York Times- we should import lots of poor Mexicans to compete with lower income Americans but obviously we can't go getting doctors who would lower the average wage in that profession because they're a protected class.

A fact that always leavs me perplexed is that the USA, a nation blessed with an over abundance of medical schools, a nation which indeed was a pioneer of medical education and for the last 100 years at least has been a the fore-front of medical research, a nation that spends untold billions on medical education and research, and crucially, every place at medical school is over subscribed manifold times by good applicants who would make good doctors - and who have the financial wherewithal to pay for their course - 'needs' to import medical doctors from undeveloped nations, nations which apparently have great difficulty in funding and training doctors. It makes absolutely no sense to me whatsoever.Perhaps a knowledgable reader can enlighten me.What is the role of the AMA in all this?, the US government?

Bostrom:Well suppose you have a moral view that counts future people as being worth as much as present people. You might say that fundamentally it doesn't matter whether someone exists at the current time or at some future time, just as many people think that from a fundamental moral point of view, it doesn't matter where somebody is spatially---somebody isn't automatically worth less because you move them to the moon or to Africa or something. A human life is a human life. If you have that moral point of view that future generations matter in proportion to their population numbers, then you get this very stark implication that existential risk mitigation has a much higher utility than pretty much anything else that you could do.

I don't have any specific remarks on this 'we have equal obligations to future people as we do to present people' view, other than to note it throws your statistics on the Zambian population explosion into rather frightening relief.

It is universally acknowledged that the profession of the medical doctor is the 'best' job there is. Isn't an nation, an advanced nation, with well established medical education - and massive over subscription of medical schools - perverse if it doesn't give those jobs to its own sons and daughters, but to the children of someone else.You note that all the strong, ancient, well governed, prosperous nation states of the world don't do this.

The nations of continental Europe do very much see the medical profession as the pinnacle of all employment and regard the profession to be the purlieu of their own children. This is not true in the UK however.The nation that did so much to develop medicine is staffed mostly by foreign doctors.This is due to the founding of the NHS in 1948 that generally wrecked medical education by making all the medical schools into state funded appendages of the civil service.Basically medical school places were rationed to save government money. In the USA, there never was a sense of racial or national 'blood and soil' solidarity, hence medical doctors are treated just like any other commodity.

A couple of decades ago, studies were done determining that there would be a large surplus of physicians. As a result, very few new medical schools opened until recently.

Few American grads go into primary care (low pay), and these jobs need to be filled by foreigners.

There are probably too many specialists, but in the American system they can create their own demand. Teaching hospitals use residents as cheap manpower, and get foreigners to fill the less desirable specialties (esp. in podunk areas),regardless of the actual need for these specialists.

Some geographic areas are so unattractive that only foreign grads would work there. These may be small towns in the middle of nowhere, or cities in particularly repulsive areas like Bakersfield.

You will have difficulty in finding a foreign medical graduate radiologist practicing in Santa Barbara.

The number of foreign doctors will decrease somewhat. More medical schools are opening. Also, osteopathic schools (basically for less academic students who couldn't get into M.D. schools)have been churning out large numbers of graduates.

This is not true in the UK however.The nation that did so much to develop medicine is staffed mostly by foreign doctors.This is due to the founding of the NHS in 1948 that generally wrecked medical education by making all the medical schools into state funded appendages of the civil service.Basically medical school places were rationed to save government money.In the USA, there never was a sense of racial or national 'blood and soil' solidarity, hence medical doctors are treated just like any other commodity.

So Britain & the US end up with large numbers of foreign doctors even though the mechanism is different.

I was at a private hospital in the UK recently and like the evil diversity hating racist Ive become I took note of the demographics of the staff.

All the doctors, nurses and other staff appeared to be white, even down to orderlies pushing wheelchairs and people doing the cleaning etc You know, the Jobs We Wont Do. TM.

True not all were British, a hot Polish nurse, a South African woman doing admin. I did see one Asian guy, could have been a Dr or possibly administrator, that was it.

The local NHS hospital otoh is a liberal's dream mixture of Asians & Africans. Though one sub group of workers remains stubbornly white in character - the paramedic/ambulance driver caste. Not 100% perhaps but very much against the grain of the wider NHS population.

Im sure there is a story to be told about the deadly effect of the NHS on immigration. We 'need' foreign Drs & nurses and very soon that becomes self-fulfilling. In the same way that the US needed someone to fill the job of Prez and luckily a half-Kenyan was willing to do that and arent we lucky.

The NYT, eh. The same people who said Depoprovera shots were inflicting even more HIV on E. Africa. Their mentality is probably closer to, "So long as they don't overflow into nice Western lands, what's not to like? My daughter works at an NGO that ships charitable CT scanners thatta way"

That will be why the NYT is so noted for its staunch anti-immigration stance then?

In Britain the NHS is a sort of black hole sucking in 3rd world doctors & nurses (no pun intended!)

But a somewhat parallel profession makes for an interesting contrast. Veterinarians. They are well paid by any reasonable standard.

In the UK they are entirely private, the state plays no general part in funding or recruitment.

I have NEVER seen or met a vet who wasnt white. Sure, some are foreign. Im personally aware of Norwegian, Australian, South African vets for example. But all white, not an Asian or African face to be seen, foreign or British born.

And the veterinary technicians, nurses, even the unqualified girls who help out (and it is almost always girls) - all white too without exception and virtually all British born.

The contrast with the medical trade is stark. I wonder if anyone anywhere has noted this or studied it?

Im quite near the Royal Veterinary College and have met students from there a few times, they too are all white. It attracts people from all over the world, last guy from there I had dealings with was from the US for example (obviously he was white).

You will note they have managed to shoehorn in a Muslim girl onthe front page of the site. Are those people models or students? Dunno. But its more likely she will study there and go home rather than become some we 'need' here.

Anyhow I note that two iSteve themes unite here. Because looking at that site I see that Temple Grandin will be speaking there in the summer.

The Pope found himself in trouble 3 years ago this month when he tried to suggest sending condoms to Africa wouldn't stop AIDS. Secular humanists swarmed over his statements like attack frenzied soldier ants.

"You will note they have managed to shoehorn in a Muslim girl onthe front page of the site. Are those people models or students? Dunno. But its more likely she will study there and go home rather than become some we 'need' here."

I don't imagine there is much, if any, 'need' for veterinarians in the Muslim world. They are not pet people.

I ask this question in all seriousness.Has somebody actually gone through the trouble to find out what efforts are actually being made in these countries regarding birth control

Steve is making a point about US media coverage, not about policy. But, in answer to your question, yes, reducing fertility in less developed countries is a more or less explicit goal of the foreign aid establishment. Lately, they've come to believe that educating women is the best way to get them to use birth control (throwing free contraceptives at them did not work so well). So, they're trying to do that all over the place.

"More than half of all students taking up scarce places at medical school are women - yet, after 10 years, 60 per cent of them have given up, leaving a huge hole in the NHS. "

Alice Thomson - Daily Telegraph 27/06/03

http://www.angryharry.com/esIstheTrainingofWomenDoctorsAWaste.htm

and hadn't read this before:

Doctor gets £500k for needle prick

BBC News

The doctor developed growing anxieties about needles, blood and Aids

A junior doctor has received almost half a million pounds in compensation after accidentally pricking herself with a needle.

June Kelly: "The BMA says the size of the damages reflects a lifetimes's loss of earnings" The doctor, a house officer in a London hospital, had not picked up any infection from the injury, but she developed a phobia about needles and is now unable to work.

This is the last country in the world where doctors can make huge coin, which ends with the implementation of Obamacare.

I had surgery at Massachusetts General Hospital two years ago; MGH being one of the top hospitals in the world. The surgeon was a Brit of Indian descent, assisted by a South Korean. The gas passer was from Iceland (and a real knockout, too). The two nurses were typical Boston Irish girls.

Perhaps someone mentioned it, but you're missing what's really going on with "stealing third world doctors." These doctors are being imported into socialized medical industries to replace the white people who increasingly are opting out of the system. As any white, US-trained doctor will tell you -- you do not want to be treated by non-whote foreign trained doctors. This does not help us. It represents the DECLINE of the western medical profession. Wise up, people. Brown people do not make good doctors. But good white doctors don't want to work in crappy socialized medical systems.

India itself has an abysmally low doctor-patient ratio. Yet indian doctors keep leaving the country that educated them and that desperately needs their services in droves.

Ditto for engineers and scientists educated in India. This aspect of globalisation may benefit America.

No, the infiltration of the top echelons of our labor market by foreigners does not benefit Americans. Even when these foreigners aren't parasitic (taking the knowledge gleaned from our system back to their own countries), they have taken valuable medical college and medical residency positions away from Americans.

There are plenty of qualified Americans wanting to be doctors but unable to get into medical school because of limited opportunities.

Then there is the data indicating that physicians don't give as good health care to members of different ethnic or racial groups. Sailer should cover that issue.

In my opinion, contraception and abortion (the visible part of the iceberg) cannot explain the low fertility rate in Europe/Asia. Therefore contraception cannot explain (but I think Sailer already know that) high fertility in Africa. The underlying problem with our countries is feminism itself. Modern women don't want babies. They are obsessed by economic success. So women substitute career for babies (this explains why women with high IQ have less babies). Even men seem to prefer women that have some economic background.

How many "foreign" med school doctors are Americans who went to one the proprietary medical schools in the Caribbean, like Ross?

Any industry that takes brain power and has more or less hard quotas or goals for various dim minorities will either "need" non-white immigrants, or the numbers of capable native nonwhites will put a ceiling on how many white doctors can practice, because they can't dilute the minority percent below the quota.

I have a pet theory that immigration of foreign doctors has a nearly opposite effect on American wages to the effect of immigration of other kinds of foreign workers.

For most lines of work, immigration drives down wages for Americans. But I believe the licensing bodes AMA, AAMC, LCME, and gatekeeping associations for the specialties in America let lots of mediocre doctors from third-world countries practice in America for typically much lower pay than American doctors receive in order to keep wages high for American doctors. Making relatively low-pay niches, such as family practice for poor people, available in the USA to heavily accented MDs from the third-world lets American-born doctors maintain a small and highly paid guild. In other words, keeping the number of third-world doctors high in the US confers special status and earning-power to American-born doctors who are smart and can communicate effectively with their American patients.

Some of the cost of this practice is paid by American premedical students who fail to earn better than a 3.5 GPA and to score in the top third of MCAT test-takers and therefore fail to gain admission to medical schools. These students would often be better doctors than the third-worlders who end up as practicing as physicians in America.

To sum up, the high MCAT and undergrad GPA requirements for all American medical schools ensures that Americans who end up in the doctor guild are much brighter and more motivated than is strictly necessary to deliver a high standard of care. This is because the guild members do not want competition from slightly dumber/less motivated Americans, who have the potential to flood the supply of MDs driving down MD wages, because they would not be obviously worse than the elect few who get into American med schools. So when extra docs are needed, more places do not open up in American medical schools; instead, American hospitals are happy to grab a lot of random MDs from the third world and put them in low-pay, low-liability spots.

According to this Guardian article, 25 percent of American doctors are foreign-trained:http://www.guardian.co.uk/education/2011/apr/04/america-steals-doctors-from-developing-countries I wonder if there is research on what countries these doctors come from and in what proportions. It would also be interesting to find out how good they are compared to American-trained doctors, and how well they performed on the MCAT (or comparable exams) relative to Americans who became doctors and Americans who were were turned away from the profession due to low scores.-Morgan C

"The only issue with contraception is how unaffordable it is to upper middle class educated white professional women, whom we definitely want to contracept themselves lest their high quality genes be passed onto the next generation."

"That will be why the NYT is so noted for its staunch anti-immigration stance then" My, aren't you the sharp little media critic on the make. Their edit staff all dwell in ZIP codes very effectively priced out of range for Mexican/Honduran/Haitian/Somali huddled masses. They couldn't care less about "immigration policy." To repeat from RWF above that's the bitter clingers' problem.

I would assume 'animal doctor' is seen as lower in esteem and reward. Outside of the affluent (ok, let's call it degenerate) West, people do not spend 10k on heart surgery for a sick pooch. So even immigrants planning to stay forever (heh) might see vet as a bubble career - unsustainable under population replacement.

African eschewal of contraception is going to make them a power to be reckoned with after Asia and Europe flop demographically, which will happen in 20 years.

If that was going to happen it would already have happened. Too many countries in Africa can't support the number of people they have, and you need excess calories to develop a class of artists, doctors, and engineers.

"Africans are the most ancient race. They have survived for millenia without western assistance."

I always assume that our lineages are equally ancient - all of us going back to that one cell in the sea. Are you suggesting that AFricans are actually descended from a different, earlier cell?

"In Britain the NHS is a sort of black hole sucking in 3rd world doctors & nurses (no pun intended!)"

IIRC, about 40% of NHS doctors are foreign-born/trained. In Britain's case it's a market failure - a formerly well-respected career path is now a poorly paid job (for your talent) in the UK's largest bureaucracy. So talented Brits don't pursue medical careers.

"Few American grads go into primary care (low pay), and these jobs need to be filled by foreigners. There are probably too many specialists, but in the American system they can create their own demand."

Perhaps. But my experience with specialists is that they have answered, in the course of a single appointment (in my case on 3 separate health issues), problems I had never resolved with my PCPs after numerous visits.

Gilbert Pinfold: “I would assume 'animal doctor' is seen as lower in esteem and reward. Outside of the affluent (ok, let's call it degenerate) West, people do not spend 10k on heart surgery for a sick pooch. So even immigrants planning to stay forever (heh) might see vet as a bubble career - unsustainable under population replacement.”

Veterinarians do not only treat pampered urban and suburban pets. They are valuable to people who raise livestock and poultry.

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